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Divine right : the adventures of Max Faraday
\"Max Faraday was an ordinary college student who spent all his time on the Internet - until the day he accidentally downloaded the Creation Equation. Suddenly able to access the limitless powers of the universe itself, this pizza delivery boy found himself the target of a secret government agency! Now, aided by a band of warriors sworn to protect the formula, Max, his sister, and his best friend must stay one step ahead of the deadly assassins and horrific demons that are hunting them down. But when his actions begin to wreak havoc across the globe, Max turns from messiah to megalomaniac\" -- summary from forbiddenplanet.com.
Book
How many children have palliative care needs and which of them are less likely to be actively seen by services? A cross-sectional analysis of survey data
BackgroundThe prevalence of children with life-limiting conditions is increasing. It is difficult to estimate palliative care needs in this population, and few studies have explored the characteristics or service use patterns of this group. The aim of this study was to estimate the number of children with palliative care needs in North West England, exploring associations between patient characteristics and service activity.MethodsAll services providing healthcare to children in North West England were surveyed to provide data on children (0–19 years) with palliative care needs within a census period (6–15 February 2023). Data collected included demographic information, diagnosis and care patterns. Point prevalence of need was calculated for all children by age group and ethnicity. Associations between patient characteristics (eg, age, ethnicity) and being actively seen by services were explored in logistic regression models.Results49 services provided data on 1694 children. Point prevalence of need was 10.1 per 10 000 0–19-year-olds (95% CI 9.6 to 10.6). Children of South Asian ethnicity were less likely to be actively seen (defined as seen or called within the census period) than those of White ethnicity (OR 0.45, 95% CI 0.32 to 0.64).ConclusionsDisparities in the use of children and young people’s palliative care services were demonstrated. Future research should focus on developing measures of complex need for palliative care for children with life-limiting conditions, as well as inclusive and appropriate interventions to address disparities.
Journal Article
Heroes reborn. Fantastic four
\"The Fantastic Four are Reborn, but it could be a short and unwonderful life as menaces emerge from the earth, the sea, and Latveria! But even the Mole Man, Namor and Doom himself pale before the threat of Galactus and his Heralds (one finally just wasn't enough)! Featuring the Avengers, S.H.I.E.L.D. and more! Guest-starring Wolverine and Franklin Richards, Son of a Genius!\"--Provided by publisher.
Book
Long term care facilities in England during the COVID-19 pandemic—a scoping review of guidelines, policy and recommendations
Background
The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area.
Aims
To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes.
Method
A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes.
Results
Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication.
Discussion
LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing.
Journal Article
Address Exacerbated Health Disparities and Risks to LGBTQ+ Individuals during COVID-19
As of August 12, 2020, there are over 20 million confirmed cases of novel coronavirus disease (COVID-19) worldwide with over 744,000 deaths.1 Due to existing disparities in health outcomes, the consequences of this pandemic for LGBTQ+ individuals could be magnified in scope and severity.2 Gay, bisexual, and other men who have sex with men (MSM), particularly those who inhabit multiple minority identities (that is, racial/ethnic minorities, immigrants), are already at greater risk for suicide, HIV, and unemployment, and commonly face systematic, institutional discrimination in the form of criminalization and other human rights violations.3 Vulnerable subgroups, such as unstably housed or informally employed LGBTQ+ individuals, may struggle to practice social distancing and prescribed sanitation measures. The recommendations presented here are data-driven and informed by a cross-sectional survey implemented by the free gay social networking app, Hornet, from April 16 to May 4, 2020. Hornet has over 25 million global users, and over 4,000 users from more than 150 countries completed this survey.
Journal Article
Understanding health service utilisation patterns for care home residents during the COVID-19 pandemic using routinely collected healthcare data
Background
Healthcare in care homes during the COVID-19 pandemic required a balance, providing treatment while minimising exposure risk. Policy for how residents should receive care changed rapidly throughout the pandemic. A lack of accessible data on care home residents over this time meant policy decisions were difficult to make and verify. This study investigates common patterns of healthcare utilisation for care home residents in relation to COVID-19 testing events, and associations between utilisation patterns and resident characteristics.
Methods
Datasets from County Durham and Darlington NHS Foundation Trust including secondary care, community care and a care home telehealth app are linked by NHS number used to define daily healthcare utilisation sequences for care home residents. We derive four 10-day sets of sequences related to Pillar 1 COVID-19 testing; before [1] and after [2] a resident’s first positive test and before [3] and after [4] a resident’s first test. These sequences are clustered, grouping residents with similar healthcare patterns in each set. Association of individual characteristics (e.g. health conditions such as diabetes and dementia) with healthcare patterns are investigated.
Results
We demonstrate how routinely collected health data can be used to produce longitudinal descriptions of patient care. Clustered sequences [1,2,3,4] are produced for 3,471 care home residents tested between 01/03/2020–01/09/2021. Clusters characterised by higher levels of utilisation were significantly associated with higher prevalence of diabetes. Dementia is associated with higher levels of care after a testing event and appears to be correlated with a hospital discharge after a first test. Residents discharged from inpatient care within 10 days of their first test had the same mortality rate as those who stayed in hospital.
Conclusion
We provide longitudinal, resident-level data on care home resident healthcare during the COVID-19 pandemic. We find that vulnerable residents were associated with higher levels of healthcare usage despite the additional risks. Implications of findings are limited by the challenges of routinely collected data. However, this study demonstrates the potential for further research into healthcare pathways using linked, routinely collected datasets.
Journal Article
A Pill for Promiscuity
2024 Best Book of the Year Award by the GLBTQ Division of the National Communication Association Finalist for Lambda Literary Award for Best LGBTQ+ Anthology For a generation of gay men who came of age in the 1980s and 1990s, becoming sexually active meant confronting the dangers of catching and transmitting HIV. In the 21st century, however, the development of viral suppression treatments and preventative pills such as PrEP and nPEP has massively reduced the risk of acquiring HIV. Yet some of the stigma around gay male promiscuity and bareback sex has remained, inhibiting open dialogues about sexual desire, risk, and pleasure. A Pill for Promiscuity brings together academics, artists, and activists—from different generations, countries, ethnic backgrounds, and HIV statuses—to reflect on how gay sex has changed in a post-PrEP era. Some offer personal perspectives on the value of promiscuity and the sexual communities it fosters, while others critique unequal access to PrEP and the increased role Big Pharma now plays in gay life. With a diverse group of contributors that includes novelist Andrew Holleran, trans scholar Lore/tta LeMaster, cartoonist Steve MacIsaac, and pornographic film director Mister Pam, this book asks provocative questions about how we might reimagine queer sex and sexuality in the 21st century.
eBook
Intimate Partner Violence Victimization During the COVID-19 Pandemic Among a Global Online Sample of Sexual Minority Men
PurposeWe aimed to describe the prevalence of IPV victimization, changes of experiencing IPV victimization, and examined factors associated with more severe or frequent IPV victimization since the COVID-19 crisis among a global sample of sexual minority men (SMM).MethodsData were collected between October and November 2020 through a gay social networking (GSN) application. We used multinominal logistic regression to examine correlates of experiencing any IPV during the pandemic and experiencing more severe or frequent IPV since the pandemic began.ResultsOf all participants (n = 9420), IPV victimization prevalence in the past 6 months was 17.0%, 19.5% of whom reported experiencing more severe or frequent IPV and 55.7% reported experiencing IPV that stayed the same since the COVID-19 started. Experiencing more severe or frequent IPV victimization since the pandemic began was associated with having engaged in sex work, having an income reduction by more than 20% and cutting meals since the COVID-19 crisis began. Increased tobacco use and psychological distress were also associated with increased IPV victimization. Lastly, SMM who reported having met a sexual partner through GSN apps were more likely to say that their experience of IPV had been more severe or frequently.ConclusionOur results demonstrate relatively high levels of reporting IPV victimization during the COVID-19 pandemic among a global sample of SMM. The findings illustrate an increasing need for IPV resources and programs as the pandemic continues to evolve. New technologies such as GSN apps have the potential to deliver confidential and safe IPV screening, services, and resources.
Journal Article
Economic, Mental Health, HIV Prevention and HIV Treatment Impacts of COVID-19 and the COVID-19 Response on a Global Sample of Cisgender Gay Men and Other Men Who Have Sex with Men
There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n = 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether sub-groups of our study population are disproportionately impacted by COVID-19. Many gay men and other MSM not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among gay men and other MSM.
Journal Article
Use of, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: findings from a 2017 large geosocial networking application survey
ObjectiveCurrently, seven European countries provide HIV pre-exposure prophylaxis (PrEP) through public health services, although there are numerous reports of off-licence use. The objective of this study was to examine current use of PrEP, likelihood of future use and indicators of potential PrEP candidacy among an opportunistic sample of men who have sex with men in Europe and Central Asia.MethodsA survey was sent out in eight languages to users of the Hornet gay networking application in July and August 2017. Descriptive statistics present proportions of PrEP use, while factors associated with PrEP use are examined using logistic and linear regressions.ResultsOf 12 053 participants whose responses came from 55 European and Central Asian countries, 10 764 (89%) were not living with diagnosed HIV. Among these HIV-negative/untested men, 10.1% (n=1071) were currently taking PrEP or had done so within the previous 3 months. Current or recent PrEP users were significantly more likely to have taken postexposure prophylaxis (adjusted OR (AOR)=16.22 (95% CI 13.53 to 19.45)) or received an STI diagnosis (AOR=4.53 (95% CI 3.77 to 5.44)) in the previous 12 months than those who had not. Most commonly, these men obtained PrEP from a physician (28.1%) or the internet (24.8%), while 33.6% had not disclosed PrEP use to their doctor. Men reporting happiness with their sex life were more likely to have taken PrEP (AOR=1.73 (95% CI 1.59 to 1.89)). Nearly a quarter (21.5%) of those not on PrEP said they were likely to use it in the next 6 months.ConclusionsThe majority of men using, or intending to use, PrEP appear to have a risk profile consistent with emerging guidance. A large proportion of these men are accessing PrEP outside of traditional healthcare settings, posing a challenge for routine monitoring.
Journal Article